Excerpt from Journal of the Massachusetts Association of Boards of Health: The Official Journal of the Public Hygienists of the State; Vols. XIII-XIV; October, 1903-November, 1904
Until comparatively recently the diagnosis of typhoid fever has been a clinical matter, notwithstanding the fact that the bacillus of typhoid was known. This was because, although known, the bacillus is difficult to isolate with suﬂicient rapidity and certainty. The introduction of the Widal reaction furnished a bacteriological method easy of application, a method which has been very widely adopted. Brieﬂy, this method consists in taking a drop of blood from the ear or finger of the patient and testing it, not for typhoid bacilli, as is often supposed by the general public, but for the pres ence of a peculiar substance found only in the blood of true typhoid fever patients. The test for this peculiar substance is made by mixing the blood to be tested with a culture of typhoid bacilli, kept for this purpose in the laboratory. The typhoid bacilli, before the addition of the blood, swim freely about in the liquid culture. On adding the blood of a well person or of a sick person not affected by typhoid bacilli, the bacilli are not affected, but continue to swim about freely, as before. But, if the patient be suffering from true typhoid, his blood will contain the peculiar substance already re ferred to; and this acts at once on the bacilli. Under the action of this substance they move more and more slowly, gathering at the same time into little groups, so that finally one sees only a few motionless masses of bacilli drifting Slowly with the current or lying [quite still.
Now true typhoid fever yields this peculiar substance capable of acting on true typhoid bacilli in this way. But what is true typhoid fever? True typhoid fever is that disease caused by the true typhoid bacilli. But the practitioner finds cases which give all the symptoms of typhoid fever, running a fairly typical course, in which repeated tests Show that the patient's blood has no effect upon the cultures of typhoid bacilli in the laboratory. Clinically, it is a case of typhoid: bacteriologically, it is not. In the last few years such cases have worried every one who has had to do with them.
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